At present, in the world, rehabilitation medicine, including hand function rehabilitation, has been widely valued, and has been promoted to the same important position as clinical practice, health care and prevention. European and American countries have emphasized the importance of hand function rehabilitation since the late 1960s, and there are physical therapists and occupational therapists who specialize in hand therapy. Due to the early intervention of rehabilitation therapy, the surgical effect and functional recovery of patients with hand dysfunction have been significantly improved. Therefore, after hand dysfunction, rehabilitation is required from tissue healing to functional recovery, from vocational training to reintegration into society.
Rehabilitation of hand dysfunction
The rehabilitation treatment of hand dysfunction mainly focuses on the rehabilitation of the function of the affected hand and the compensatory training on the healthy limb. The main treatment methods are as follows:
1. Physiotherapy
Intervention is mainly started in the early stage. Cold therapy is one of the commonly used physical therapies in clinic. Low temperature can reduce nerve excitability and conduction velocity, which has a blocking effect on sensory and motor nerves, and can block or inhibit various pathologies Exciting foci, so there are analgesic and antispasmodic effects. Electrical stimulation therapy is also a widely used method. For example, 100 Hz and 50 Hz signal-type functional electrical stimulation has a significant effect on upper limb motor function in elderly patients with hemiplegia in stroke units.
2. Exercise therapy and occupational therapy
The upper limb function, especially the fine motor impairment of the hand, seriously affects the daily life activities of patients and causes a heavy burden to the family and society, which is the most difficult point of rehabilitation work. In the early stage, passive joint activities and massage are mainly used, and in the functional recovery period, active hand function training and life ability training are mainly used.
3. Compensation training for the healthy side body
80% of nerve fibers emanating from the precentral gyrus cross to control the movement of the opposite side, and a small part of them do not cross and directly descend to form the anterior corticospinal tract to control the movement of the same side. Therefore, after stroke-induced damage to one cerebral hemisphere, due to the existence of non-crossing fibers, it also affects the function of the upper limb and hand on the same side. Therefore, proper training of the non-hemiplegic side hand should not be overlooked.
4. Traditional rehabilitation techniques
Acupuncture, massage, traditional Chinese medicine fumigation and new traditional Chinese medicine rehabilitation techniques are widely used in the rehabilitation of hand dysfunction after brain injury. Transcutaneous acupoint electrical stimulation therapy is a treatment method frequently used in recent years, which can control the pain and edema of the affected limb and lay a good foundation for improving hand function.
5. New progress in the treatment of hand dysfunction
Biofeedback training: The biofeedback training system based on modern information technology is an emerging rehabilitation training mode, which can not only improve the range of joint motion, increase muscle strength, improve finger coordination, but also continuously stimulate the joint position sense of the limbs and promote movement. The sensation is restored, and the ADL ability of the patient such as eating, washing, putting on and taking off clothes can be improved.
Motor imagery therapy: refers to the process of repeatedly simulating and rehearsing motor activities in the heart without obvious physical activities, and activates a specific area in the brain according to motor memory to achieve the purpose of improving motor function. Motor imagery training combined with routine rehabilitation can improve upper limb motor function in chronic stroke patients.
Interactive technology for hand function rehabilitation (brain-computer interface technology): it is to directly establish a communication channel between the brain and the surrounding environment, and convert the neural activity information of the brain into commands to drive external devices without relying on the peripheral Nervous system and musculature.
Mirror therapy technology: mirror therapy is an emerging technology for the treatment of hand dysfunction after stroke, which can promote the generation of cerebral cortex by activating the motor-related brain regions (lower precentral gyrus, premotor cortex abdomen) and the MNS in the inferior parietal lobule. Plasticity changes and functional reorganization to improve unilateral neglect and motor dysfunction in stroke patients.
6. Hand function aid engineering
With the continuous changes in the concept of rehabilitation therapy, assistive devices are not only used as a technology to compensate the patient's function, but its value is reflected in all aspects of the rehabilitation process of stroke patients. At present, the auxiliary devices used for hand function rehabilitation mainly include: fingerboard, pneumatic gloves and elastic assisted hand orthosis, hand exoskeleton device, robot-assisted technology, brain-computer interface technology, etc.
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